Early-life environmental exposures and anaemia among children under age five in Sub-Saharan Africa: An insight from the Demographic & Health Surveys

Background: Reports show that the majority (60%) of children under age five years in Sub-Saharan Africa are anaemic. Studies in the region have mainly focused on the effect of individual, maternal and household socioeconomic status on the prevalence of anaemia. Currently, there is limited understanding of the association between early-life environmental exposures and anaemia among children in Sub-Saharan Africa. Objective: The study examines the association between early-life environmental exposures and anaemia among children under five in Sub-Saharan Africa. Methods: The study used health and demographic data from the Demographic and Health Survey (DHS) program and environmental data from NASA's Geospatial Interactive Online Visualization ANd aNalysis Infrastructure (GIOVANNI) and Atmospheric Composition Analysis Group. Three exposure periods were defined for the study, namely: in-utero, post-utero and cumulative life exposures. Multilevel mixed-effect models were used to assess the associations between environmental exposures and anaemia in each exposure period. Results: The findings show that 63% of children in the study were anaemic. It also reveals that mean PM 2.5 exposure for in-utero (34.93 μgm⁻³), post-utero (35.23 μgm⁻³) and cumulative exposure (35.08 μgm⁻³) were seven times higher than the new air quality guideline WHO recommended. A 10 μgm⁻³ increase in in-utero, post-utero and cumulative PM 2.5 exposures was associated with 4% to 5% increase in the prevalence of anaemia among children. A 10ppbv increase in in-utero, post-utero and cumulative carbon monoxide exposures was associated with 1% increase in the prevalence of anaemia among children. The spatial risk distribution maps show that socioeconomic factors modify the spatial risk distribution pattern. Conclusion: The findings of the study suggest that early-life exposure to ambient air pollution is significantly associated with anaemia among children in Sub-Saharan Africa. Thus, policies aimed at addressing air quality should be incorporated into targeted interventions for anaemia among children in the region.